Ex Vivo Lung Perfusion (EVLP) for Transplant Optimization

The success rates of lung transplantation as a definitive therapy for end-stage lung disease is becoming extremely limited due to the scarcity of compatible organ donors. Many lungs have been discarded from donors’ bodies as they have concerns on its functionality and whether or not it had been injured. Because of this, Ex Vivo Lung Perfusion (EVLP) was invented as a solution. This allows donor lungs to be ventilated and perfused outside the body under near-physiological conditions. Because of this, clinicians are able to assess lung function, and perform interventions to ensure that all organs are in good condition before transplantation.

Ex Vivo Lung Perfusion (EVLP) was first introduced in 1970 as a technique to evaluate the quality of the donor organ in animal models of lung transplantation (Fisher, 2016).  Since then, it has been introduced into clinical practice, and is continuously gaining recognition and global widespread as a technique to preserve donor organs. 

The technique involves keeping donor lungs in a sterile environment, mimicking the human body. As Northwestern Medicine (n.d.) had described, this process is done within 3-4 hours in a plastic dome with a ventilator, pump, and filters. The lungs are then maintained at normal body temperature and treated with bloodless solution which contains the necessary nutrients, proteins, and oxygen. The lungs are placed in a plastic dome and attached to a ventilator, pump and filters. This process helps determine if the lungs from deceased donors are sufficient enough and are of the right quality with no injury before it is given to a recipient on the United Network of Organ Sharing (UNOS) waitlist. 

This technique continues to give promise that will shift current practices in transplantation. Comparing it to the traditional cold storage method, it truly shows more advantages. Using the cold storage method, there are limitations in the time an organ can still be transplanted, leaving many organs to decay, becoming unusable. Trials have shown that lungs that are subjected to EVLP have shown better outcomes when transplanted into the patient, as well as better function. With the continuous development of EVLP, it could grow to become more than a tool for organ preservation, but also as a gateway for future regenerative strategies (Halpern, 2021). 

To conclude, EVLP has made great advancements in the field of organ transplantation, specifically for lungs. This has offered more patients a second chance at life as it expands the donor pool and has been proven to improve patient outcomes after transplantation. With this, it is sure that many patients on the UNOS waitlist will be able to obtain healthy and functional lungs.

by Sophia Perez at Incisionary

APA References

 Fisher, A., Andreasson, A., Chrysos, A., Lally, J., Mamasoula, C., Exley, C., Wilkinson, J., Qian, 

J., Watson, G., Lewington, O., Chadwick, T., McColl, E., Pearce, M., Mann, K., McMeekin, N., Vale, L., Tsui, S., Yonan, N., Simon, A., . . . Dark, J. (2016, November 1). Introduction and background. an observational study of donor ex vivo lung perfusion in UK lung transplantation. DEVELOP-UK - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK396537/#:~:text=Ex%20vivo%20lung%20perfusion%20was,animal%20models%20of%20lung%20transplantation.&text=Subsequently%2C%20porcine%20studies%20showed%20that,developed%20by%20Steen%20et%20al.&text=in%20Sweden%20to%20assess%20lungs,EVLP%20prior%20to%20successful%20transplantation.&text=Further%20experimental%20work%20in%20human,oxygenation%20and%20pulmonary%20vascular%20resistance.&text=This%20led%20to%20the%20first,prior%20to%20successful%20lung%20transplantation. 

Northwestern Medicine. (n.d.). Ex vivo lung perfusion (EVLP) for lung transplantation. 

Northwestern Medicine. https://www.nm.org/conditions-and-care-areas/pulmonary/lung-transplant-program/ex-vivo-lung-perfusion

Halpern, S. E., Kesseli, S. J., Au, S., Krischak, M. K., Olaso, D. G., Smith, H., Tipton, G., 

Jamieson, I. R., Barbas, A. S., Haney, J. C., Klapper, J. A., & Hartwig, M. G. (2021). Lung transplantation after ex vivo lung perfusion versus static cold storage: An institutional cost analysis. American Journal of Transplantation, 22(2), 552–564. https://doi.org/10.1111/ajt.16794.